Turn an adherence list into an investigation queue
Learn proportion of days covered, explore a simplified PDC recovery calculation, and organize medication adherence improvement work for Medicare Part D.
Reconcile before contacting
Confirm that the most recent claims were loaded and accepted. Check whether reversals, a medication change, or a member match issue explains the apparent gap. Record the date and source of the evidence you reviewed.
Ask what is still possible
Separate the current rate from the best achievable result in a simplified model. A deadline can help organize work, but the actual production measure must use the complete licensed specification and a validated treatment period.
Name the barrier and owner
Design the queue so a pharmacy question, transportation barrier, language need, and unresolved clinical question can go to the appropriate team. Keep the member’s preferences and contact permissions with the workflow.
Measure resolution, not just attempts
Track an attempt separately from a conversation, a reported resolution, and a later qualifying claim. Review unresolved records again when new data arrives. A sent message is evidence of activity, not evidence of improved adherence.
Take this to your next review
Bring a dated source, the assumption you are using, the person responsible for the next action, and the evidence you will review. Keep official methodology separate from local planning choices.
Reference desk
These resources support the program context. The workflow above is AdherenceStar’s suggested practice, not a CMS-mandated procedure.
CMS · 2026 technical notes ↗